Breaking Down Barriers: How Safe Yakima Valley is Transforming Substance Use Prevention

Welcome to the Safe Yakima Prevention Connection podcast, your go-to podcast for all things related to substance use prevention and healthy living in Yakima County, Washington. We are Safe Yakima. Every other week we will bring expert insights, inspiring stories, and practical tips to help our community stay safe and substance free. Let's get started.

My name is Katie Goodale. I am the Program Manager for Safe Yakima Valley and my co-host is. Hi, my name is Marisol Esparza. I'm the Drug Free Community Coordinator for Safe Yakima Valley. I would like to welcome our guest today, Alicia Stromme Tobin, who is the Executive Director of Safe Yakima Valley.

Good morning.

Yeah, so today we're excited to dive into some important topics that really get through the heart of what we do here at Safe Yakima Valley and how we're working together to build a safe and healthier community. Alicia, can you tell us a bit more about yourself and your journey to becoming the Executive Director of Safe Yakima Valley?

Absolutely. So I come with 26 years of banking experience. During that time, I always volunteered in the community having a mass over 10,000 hours given back to the community. So I definitely have always had a passion for it. And the honest answer is; I felt extremely blessed that our two boys had grown up and they were not addicted to substances. They went to college. They launched their careers, and the feeling I had in my heart, I kept saying to my husband as I felt grateful and blessed because our boys had lost friends to the fentanyl epidemic. And so I told my husband, I really want to do this work full-time moving forward. We've launched our babies out of the nest, And I truly wanted to make a difference in the community. And what if I were to get involved in community work, particularly in substance misuse prevention? Primarily, it is I have two brothers that struggle with substance use. And I also, again, I go back to my boys having lost friends. In fact, they lost another friend just a couple of weeks ago to overdose and so just wanting to make a difference in seeing there's absolutely a need in our community, And there is a lack of focus on prevention. And I think we need to get back to our grassroots and take it further upstream and make sure that we can stop hitting these huge numbers that are going through treatment and recovery.

So you've got a real personal connection with the issues?

Yes, absolutely.

So looking forward to the coming year for safe Yakima Valley, what are some of the primary goals that you have for safe Yakima Valley in the coming year?

Well, I would say one thing I'm particularly proud of is growing the team. Obviously, we were a team of three and now we're a team of eight plus, we have four youth that we employ.

So continuing to build on that momentum in our prevention work, definitely want to stay in the lane of prevention. Although, as you guys are fully aware, we do dabble somewhat in harm reduction because there's some gray area there and it's now part of prevention work. We want to continue to expand our programs in the lower valley, so when I first started, we were strictly in proper Yakima. And that was one of my primary goals when I interviewed with the board is expanding our programs to the entire Yakima County since that's what we profess to be. And so, we have done so, but we want to continue to grow and build on that momentum. We have successfully, this year, integrated to OD map in Yakima County. So taking those numbers from OD map and building a spike response team in the county, as well as putting together some task force that, between treatment providers and law enforcement are hitting our top areas where overdoses occur in the community, continuing to build on our brand recognition so that people have an understanding what we do. So when I first started, there was, I never heard of you. We don't know what safe Yakima is. Now, as we hear you, we see you everywhere, what exactly do you do? So, building onto that. Continuing to work on collaboration, community collaboration, that is something we do very well at safe Yakima. And so breaking down those silos and ultimately reducing stigma as it comes around medication for opioid use disorder. So that would be another primary goal. I think we've made tremendous progress as it comes to stigma in Narcan, but we want to do the same with medication for opioid use disorder because I truly believe that's a game changer in saving lives.

So you mentioned OD map. Can you give us just a little bit more about what OD map means, what that is, what that project was?

Absolutely. So when I first started, started getting some of the data about the overdose numbers in Yakima County and noticed that we have received, I believe it was 89 in 2021, we had 89 overdose deaths. I reached out to our county corner and said, do we know how many people survived an overdose last year? And the response was, we don't track that. So then I reached out to multi-care instead of all the people that you guys treated last year, How many people survived an overdose, they didn't track that. So I reached out to the state, went to the King County Medical Examiner's Office. They also didn't track that. And so for me, it was a question of how are we addressing a problem when we don't even know the size or the magnitude of the problem? And so I stumbled upon a booth at a conference that advertised OD map, which is a product of HIDTA, high intensity drug trafficking area. And basically what it does, it allows our first responders, our hospitals, our law enforcement Officers, to connect their dashboard to an interface that as they're entering reports of overdoses, it translates and populates the OD map interface in near lifetime. And so we know when we have spikes in certain areas, what maybe we have a bad batch of fentanyl. And so then we can now address that problem and get ahead of it before it kills more people. So we can dispatch OD response teams and let them know that there's fentanyl test strips available to never use alone, to distribute Narcan, fentanyl test strips, to stagger their use. And again, it's all about saving lives. And ultimately the goal when we do this outreach is to let them know that there is medication for opioid use disorder out there to help them with their severe withdrawal symptoms. And that treatment works. And so, getting them stable enough because we don't have medical detox yet in Yakima County through MOUD, and then transitioning them to treatment so that they can now start their life and rebuild their life.

Great.

Yeah, I'm going to go back and highlight the aspect of silos, So starting in more into the challenges in our community when we talk about breaking down siloed, we're referring to the need to overcome barriers that keep organizations from working together. So imagine if each group is working on its own separate tower or silo and rarely communicating with others outside of their walls. This can make it hard for everyone to align their efforts and truly collaborate with one another. So knowing there are silos in our community, certain agencies have worked independently without much collaboration. So silos often form a community's duty-briety of factors such as differing goals, lack of communication, and sometimes competition for resources. These barriers can lead to organizations to work in isolation. So how have you found success in breaking down some silos in our community?

I would say I tap into my experience of being on the Crime Stoppers board, which I've served on for 25 years now. We work well. We're an independent agency, but we always collaborate with law enforcement. So I have tremendous relationships with law enforcement as well as with our schools because they have the Crime Stoppers in schools. And I recognize there was a lot of silo building in Yakima County. And just through my business background as well as our training and prevention work, there was an immediate recognition that we had to break those down. And so it really was meeting them where they're at, what their goals were, and aligning them with our goals. And they aren't always going to align, but just an invitation to the table. I think there's also silos between public health and public safety. So while we all come to the table with the same goal, we approach it different ways. And so letting people know like we aren't going to push our agenda on you. We want to hear your perspective. And then you can hear ours. And then we're going to find those common threads and build from there. And I think we've done a tremendous job of doing that. What is it that you do? Well we do that too. Can we work together on that? And really reaching out to our fellow coalition partners to determine what projects are they working on? Can they have an invitation to the table? And we all as coalitions do so well at reaching out and bringing people together. Why can't we just amass and make it even bigger? Because as we know through our training, the more that we work together, the greater the impact for our community members and our community as a whole.

I would imagine that one of the primary things between public health and public safety is there's really a language difference. You really have to come to a common language because public health is going to call someone a patient where public safety may call them a suspect or a perpetrator. So even coming to a shared language seems like that would be one of the first starts of really letting those groups work together.

Absolutely. And one of our projects through OD map in our overdose response is putting together and teaming together treatment and recovery centers with law enforcement to do ride-alongs to our high-spike areas by Union Gospel Mission and by neighborhood health on Naches Avenue. Those are two known areas that need a lot more attention in the community. And so Chief Janice, Yakima Police Department, volunteered and said, you know, I'd be happy to do this for us to come together. And so we organized a triumph, We invited Merit, Comprehensive Health, Barth Clinic. And they ultimately have been participating in ride-alongs, and both of them, even after their first ride-along, were astonished in how much they learned in just a couple hours of going back and forth between those two neighborhoods and their approach. In one particular case, law enforcement said, this gentleman, we've really tried to have him conversate with us and engage with us. But he hasn't. We've tried for a couple of years now. And one of the navigators got out of the car and they were wearing an Oregon Ducks jacket. And the person immediately was of an Oregon duck fan in the conversation started. And when they got back in the car, the law enforcement officer was just blown away at the connection. So really these ride-alongs are about building trust with that community because their trust has been violated so much. And again, letting them know about the solutions. There aren't enough case managers in this community to give individualized service. And so, the more that we can let people know that resources are available, and the more we can repeat ourselves, they may not be ready yesterday, but maybe tomorrow they will be. And so, repeating ourselves and building on that relationship where they see, oh, law enforcement works really well with treatment. And so, it reduces the barriers and makes people feel like they're sincere about their efforts and trying to get them help.

That's awesome. So, let's dream for a minute and let's just kind of let our imaginations run wild. What do you think Yakima Valley might look like if we have more successful and bigger successful collaborations between agencies that are working in prevention?

I think for me when I look at obviously the ultimate goal in prevention is we're saving more lives, right? And that that impact is that we're getting ahead of the curve. We're getting further upstream. So fewer people are going to treatment and recovery. We're always going to need all three buckets, but ultimately it is as we're having outreach events. And again, I think we've made tremendous progress in the last couple of years where people are reaching out, hey, I have an outreach event. Can you bring your resources? We just did the sequential intercept mapping project. It's coming to a conclusion where we have a report now that identifies all the resources from prevention all the way through reentry as well as the gaps that we have in our community. So ultimately the true collaboration as we come together as a community is looking at those gaps and identifying what we can do collaboratively to fill in those gaps. And one of the biggest takeaways is a medical detox. We lack that. We need it. But it is going to take full and complete collaboration in this community because funding is lacking right now. So, we're going to have to be very creative about how we want to bring that. But once we get there, as well as getting more prescribers prescribed on MOUD, which again, we can't do that work alone. It's going to require collaboration. Ultimately, we're going to see it impact the unhoused population. We're going to see it impact our youth. We're going to see it impact our families. We're going to see it impact our hospitals because they're going to have fewer patients. And ultimately, we're going to have healthier people and we're going to save more lives.

So, mentioning the SIMS project in the report that's about ready to come out or has come out. Is that going to be information that's available to the general public or is it hospital?

Ultimately, obviously, if the public inquired about it and they had specific interests at a particular intercept, what gaps and resources exist, we're more than happy to share that. There is no way to truly disseminate it. It's a very large report. It's a very comprehensive report. There's a lot of technical language in it. But those that participated in the sequential intercept map for the opioid epidemic, every single one of them will get the final copy at their agency.

Knowing we have tons of resources for the communities. What advice would you get to someone who wants to get involved in community service or substance misuse prevention? Any key resources or programs in particular?

I would say if they want to get involved in prevention, the place to start is to get involved with a coalition. So truly what a coalition does, I didn't even know what a coalition's true definition was before I got into prevention work, is different sectors in the community, whether you're a youth, you're a parent, you're a business person, law enforcement, you're in the media, you are representing faith-based community treatment recovery. There was a place where you want a coalition. And so you can learn that, okay, coalition is truly about collaboration. There's no limit inside. We can be as big as we want to be. In fact, we want to get as big as possible. It requires minimal investment of your time. It's an hour a month. And you learn the basics about prevention, how we design logic models, how we determine what are the problem areas in our community? Because as you know, we will say it every day that local problems require local solutions. And so the coalitions look at the data and we determine, okay, this is what our local problem is, what's going to be our local solution. And so the coalition gets to contribute to that. From there, people can determine what their passion is. And if they have more time to invest, maybe they head up a committee or ultimately, we have one community member that is separately outside of the coalition going around to different agencies to determine how many prescribers have medication for opioid use disorder training. And do they know how to microdose and will gather that information and then submit it back to us. But at the end of the day, I would say, what is most important in this community is to get educated. Just like with Narcan, we had some people that believed that Narcan enabled people to continue on with their substance use. And as one of our local drug court judges had said so eloquently, you cannot treat a dead person. So Narcan is not treatment. It is not prevention. It is a lifesaving tool. And it is harm reduction. Harm reduction is in its own category. And so we have to make sure that we get the person stable enough to accept and be ready to get the treatment. We need to do the same with medication for opioid use disorder. And we need to applaud those that are in recovery similarly to when somebody's in recovery from cancer. It is a brain disorder. And so again, through education, we can let people know. We can show them the MRIs. And once you can eliminate that stigma where people are going to be willing to come forward and get the treatment they need.

So, you mentioned MOUDs a couple of times. So, let's go a little bit deeper with that. What locally, what are those resources that are available for people that are struggling with opioid disorder?

So, I would say locally, there's actually a few organizations. Yakima Valley Farm Workers Clinic has prescribers. We have comprehensive health care that has prescribers. Yakima Neighborhood Health Services, Central Washington, Community Health also has it. So, there are prescribers out there. There are not as many as we'd like to see. Comprehensive also goes to our County Jail and administers it to those that are in need at the County Jail to help them their withdrawal symptoms and hopefully get them in a position that when they reenter society, they're ready to get into treatment and they're somewhat more stable. But medication for opioid use disorder is definitely an area of opportunity for Yakima. And one that Safe Yakima will help and collaborate to get the availability and increase the availability as much as possible, particularly those rural areas where transportation is an issue and they have limited resources there. Our goal is to expand the services through Comprehensive potentially and others that can have expand their mobile unit. But also looking at working with emergency services to partner paramedics to ride along with DCRs that respond to overdoses. So, when the paramedics revive somebody and they can now EMS can leave the scene. But the assigned paramedic to that DCR can continue on and offer medication for opioid use disorder on the site to say we can help you with your withdrawal symptoms. Give them that 28-day injection and then hopefully get them transitioned to a place like ideal options to get them a longer prescription and then transition to someplace for care.

Great. Thank you. So, you've mentioned a few, but are there any other upcoming projects or initiatives that safe Yakima Valley is involved with that you're the most excited about?

I would say all of the above as well is again our prevention projects. We're going to be adding four schools to our positive social norms campaign which last year when we had four schools that participated the results were amazing. We had youth that reduced substance use 30-day substance use anywhere from 15 to 50 percent depending on the school and depending on the substance. We had youth that were choosing healthier alternatives to cope with stress and anxiety. They were listening to music more. They were exercising more, and they were taking walks more and they were hanging out with friends more. They were drawing more, reading more to decompress and that was all as a result of the campaign. We also were correcting misperceptions about youth substance use. So, the community, parents and even youth overwhelmingly overestimate the number of youth using substances when the true norm is that the overwhelming majority are not and so helping spread that word I think is going to be critical. The other thing is one particular community is near and dear right now to our hearts and that's Sunnyside with the recent homicide and so trying to wrap around as many protective factors in that community is possible. We want to see zero youth lose their lives moving forward and so really rallying in that community to let them know there are plenty of resources to help them with that.

So a community member who's hearing us today and understanding that "Wow there really is some things that need to be done there's there is something that we can do. It's not a hopeless situation." What can they do or how can they get in touch with Safe Yakima Valley to be involved in some of these things that are going on and we haven't even mentioned our mentoring program which is another way that the community can certainly get involved with what we do here.

Absolutely well and that's more with the mentoring program obviously that's a required four hours a month and a nine month commitment so that's where I say they want to get started, they may want to try the coalition side, it's only an hour but once they invest and they determine oh I think I have more time. I want to do more of this. I feel like I'm getting more passionate about it than it would be a lovely transition to become an adult caring mentor for an elevated risk youth. Obviously, we know that it's evidence-based and it has a significant impact on those youth. They are 46 percent less likely to use substances. They are more likely to participate in sports. They have better attendance, better academics. They have higher graduation rates. They are more likely to attend college and one of the other ones that I think is pretty cool is, there's 70 percent more likely to volunteer in their communities as adults because somebody took the time to volunteer and spend time with them. For anybody interested just learning more they can of course call us at 509-248-2021 extension 112 or they can go on to the Safeyakimavalley.org website and request more information or if they know I'm sold I want to do it right now. They can just sign up for a coalition or be a mentor right on her website.

We do have coalitions that meet in Yakima proper also with coalition that meets in Toppenish and one that meets in Grandview. So if you're in the lower valley there's still opportunity to be involved for sure.

Absolutely and they don't have to reside in those communities. So if somebody from Selah says I want to be on the Yakima coalition we do have Selah members of somebody in Tieton who wants to join the coalition union gap. They absolutely can. Same with White Swan and Herrah and all those small communities they're more than welcome to join us at the Toppenish coalition and in the lower valley Sunnyside, Granger, Mapton in all those lower valley communities also can join us in Grandview and there are other coalitions. So White Swan community coalition, Granger has a coalition Sunnyside Unidos, and ESD 105. So again, just get involved whether it's with Safe Yakima Valley or one of the other coalitions. We just want to join hands as much as possible to make as great an impact that we can.

Great. Thank you so much Alicia. Thank you for being with us today. Every time we talk, I always feel a new surge of hope that there is something people can do, that we're not hopeless. This is not oh my goodness what's happening it's never going to get better. When we all get together, we all work together. We can make a difference in our community.

Absolutely and in closing I will tell you an example of that that has me energized today is we're doing a pilot with one of our elementary schools in town that has youth that are habitually gone and we're talking three four five days a week and so we enrolled out a positive ticketing program with 20 kids basically a reward system that is rewarding them for their attendance and they have to attend at least three days a week and so they get points if they attend at least three days in the week just to start with for each of the weeks between now and the end of the school year; they also get more points if they attend four days and five days and then they get to redeem those points for prizes. After our first week we had 11 kids who came to school five days last week.

That's awesome.

We had 19 of the 20 kids at least come through days and so we're already seeing the effects and evidence shows you can reprogram the brain with positive reinforcement and so that's what this project is all about so just with that I will say we are making a difference.

Awesome thank you so much.

Thank you Alicia.

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